1. Field Of The Invention
The present invention is directed generally to an apparatus for use in performance of ankle arthroscopy and more particularly to an apparatus used to provide distraction of the talo-tibial joint during performance of arthroscopic surgery of the ankle.
2. Description Of The Prior Art
Providing traction to various portions of a patient's body is a well established method of providing therapy to overburdened muscles, tendons and ligaments. Over the years, numerous devices have been proposed for providing various types and degrees of traction to different body parts. For example, U.S. Pat. No. 1,837,037 to Gillberg discloses a rather complicated device used to provide therapeutic traction to a patient suffering from excessive contraction of the muscles, ligaments and tendons. The device is a self-supporting unit used in connection with an operating table or hospital cot and provides traction to arms, legs or other body parts by way of suitable harnesses.
U.S. Pat. No. 3,086,519 to Pari provides a very simple device used to provide traction for a patient in a standard type bed. The device is contemplated for use at home to provide traction without requiring alteration of a standard bed.
A self-contained, portable traction device is described in U.S. Pat. No. 4,114,611 to Lyle et al. and is contemplated for use in the home, office or hospital. The device includes a longitudinally elongated frame within which the patient is situated. The frame is biased outwardly by spring within its structure, such that tension is applied across various body parts when the patient is connected within the frame by way of suitable harnesses.
U.S. Pat. No. 2,034,680 to Longfellow discloses a device used to provide therapeutic traction to an injured leg. The device includes a self-supporting frame which is used in conjunction with a bed and is constructed such that the patient is able to use a bedpan without disturbing the positioning of his leg.
In U.S. Pat. No. 1,950,948 to Murray, a device is disclosed which is used in the performance of a therapeutic technique known as circumductory manipulation. The device comprises a table structure which includes apparatus for the performance of the circumductory manipulation of various body parts, as well as for applying tension to the body parts so as to tend to elongate the tissues which are being treated.
It is also well known that it is often useful to provide traction to body parts in order to manipulate and set fractures. Various apparatus for the inducement of traction have been proposed for this purpose. For example, U.S. Pat. No. 1,239,789 to Hawley discloses a device used as a foot and leg support connection to an orthopedic table during operation on fractured bones. It allows the operator to manipulate positioning of the foot and leg, while maintaining the affected bones in constant relative positions.
Similarly, U.S. Pat. No. 1,188,711 to Wilting discloses an apparatus for attachment to an orthopedic table and utilized during the setting of fractured bones. It provides tension to the leg so as to allow the surgeon to more easily manipulate the bones. The device includes means to adjust the tension applied to the legs or other body parts and downwardly extending legs to support the device.
In U.S. Pat. No. 1,576,781 to Philips, an apparatus is proposed which is utilized to induce traction to fractured bones so as to reduce deformities and malpositioning of fragments. It is also useful in positioning the body parts during X-rays and the like.
U.S. Pat. No. 1,853,693 to Masland discloses a surgical stirrup appliance for the ankle which is adjustably disposed about the foot and ankle in a proper angular relationship. The device may be attached to a tensioning apparatus for use in inducing traction to a fractured limb so as to aid in fracture reduction.
While the above-described devices are each useful in certain circumstances and for certain purposes, none of them contemplate nor provide for the application of tension to the foot and ankle in order to distract the talo-tibial joint so as to allow for the performance of ankle arthroscopy. The foot and ankle harnesses disclosed in these patents fail to provide the proper positioning and tensioning necessary for the distraction required in the performance of arthroscopic surgery on the ankle. Furthermore, the structures disclosed for providing tension are either very complicated, disadvantageously arranged such that they interfere with and limit the positioning of the surgeon during the operation, or simply inadequate for providing the necessary distraction.
Two articles relating to ankle arthroscopy have been published in Arthroscopy: The Journal of Arthroscopic and Related Surgery. A first of these articles "New Concepts (Distraction) in Ankle Arthroscopy" by James F. Guhl, M.D., describes a technique and apparatus for use in distraction of the ankle. The distractor apparatus utilizes placement anchor pins embedded into the bone on longitudinally opposite sides of the talo-tibial joint and a helical screw/nut arrangement which, upon operation, produces outward force against each of the anchor pins. This apparatus will allow the surgeon to produce distraction in the joint but has the disadvantage that it is intrusive, as well as that the apparatus is necessarily arranged across and in proximity to the joint such that it interferes physically with performance of the arthroscopy. A second article "A Simple Distraction Technique for Ankle Arthroscopy" by Carlan K. Yates, M.D. and William A. Grana, M.D., describes a nonintrusive method and apparatus for use in performing ankle arthroscopy. The method utilizes an ankle engaging device formed from Kerlix gauze dressing wrapped and tied about the ankle and foot in a particular manner shown in FIGS. 1-4. The Kerlix gauze is situated such that it wraps around the calcaneous of the foot and over the dorsum of the foot and provides a downwardly extending loop end which is dropped to the floor, such that the surgeon's or assistant' s foot can be placed therein in order to provide downward traction and thus distraction of the joint. With this foot engaging device formed by the Kerlix gauze, the amount of plantar and dorsiflexion can be adjusted by the movement of various loops of the tied gauze material. This arrangement, while an improvement over the intrusive method of the first mentioned article, is disadvantageous in that the wrapping and tying of the various loops of the gauze is cumbersome in that the adjustments to the amount of flexion are made with difficulty and possible inaccuracy due to the nature of the wrappings. Furthermore, the fact that the surgeon or assistant must place his foot in the downwardly extending loop and provide distraction thereto causes either the surgeon or assistant to be less mobile in his efforts to perform the surgery and further does not allow for a constant and readily adjustable tension upon the distracted joint.